Outcomes in lattice degeneration

BPEI Biostatistics Center

Author

Lomas Persad

Published

March 20, 2025

Project details

Hypothesis:

Patients with lattice degeneration alone who undergo prophylactic intervention will not have improved outcomes compared to those who are observed. However, those with lattice degeneration with holes may benefit from prophylactic treatment.

Rationale:

Lattice degeneration is seen in 30% of patients with retinal detachment. However, a natural history study of lattice degeneration by Byer in 1989 concluded that lattice degeneration progresses to retinal detachment in only 1.08% of eyes. Byer’s study concluded that prophylaxis for lattice degeneration was not indicated in a majority of cases. However, the study was limited by small sample size (n=276 patients, 423 eyes) and poor follow-up rates. The purpose of this study is to explore the natural course and clinical outcomes of prophylaxis for lattice degeneration in a larger, more contemporary, dataset (IRIS).

Data extraction

graph TD
    A[<b>LD dx between Jan 2013 - Oct 2024 <br> 2,466,251 eyes, 1,551,502 patients </b>]
    A --> B[<b>Exclusions</b>: <br> - <u>Missing laterality</u>: <br> 111,753 eyes, 53,074 patients<br> - <u>Loss to F/U</u>: 979,067 eyes, 623,785 patients<br> -<u> Missing demographic data</u>: 523,430 eyes, 331,437 patients]
    
    B --> C[<b>Remaining</b>: 852,001 eyes, 543,206 patients]
    C --> D[<b>Observation group</b>: 719,173 eyes, 479,454 patients]
    C --> E[<b>Prophylaxis group</b>: 132,828 eyes, 109,930 patients]
    
    D --> F[<b>LD</b>: 689,428 eyes, 465,133 patients]
    D --> G[<b>LD+ hole</b>: 29,745 eyes, 25,190 patients]
    
    E --> H[<b>LD</b>: 112,097 eyes, 94,740 patients]
    E --> I[<b>LD+ hole</b>: 20,731 eyes, 18,416 patients]

Summary of data

Tables

Table 1: Demographic characteristics of patients with Lattice Degeneration

Variable

N = 543,2061

Sex

Female

312,716 (58%)

Male

230,490 (42%)

Race

Asian

26,648 (4.9%)

Black Or African American

46,424 (8.5%)

Other

63,247 (12%)

White

406,887 (75%)

Ethnicity

Hispanic Or Latino

36,518 (6.7%)

Not Hispanic Or Latino

506,688 (93%)

urban_rural

Rural

45,341 (8.3%)

Unknown

1,238 (0.2%)

Urban

496,627 (91%)

Region

Midwest

102,917 (19%)

Northeast

115,382 (21%)

South

179,495 (33%)

U.S. territories

1,847 (0.3%)

Unknown

78,382 (14%)

West

65,183 (12%)

Follow up (months)

54.50 (56.63)

1n (%); Median (IQR)

Table 2: Summary of eyes with RD

Observation, N = 719173

Prophylaxis, N = 132828

Characteristic

N

No RD
N = 689,3361

Yes RD
N = 29,8371

N

No RD
N = 127,0971

Yes RD
N = 5,7311

Age at LD diagnosis

719,173

59.00 (46.00, 68.00)

57.00 (49.00, 64.00)

132,828

57.00 (46.00, 64.00)

56.00 (49.00, 62.00)

Right eye

719,173

337,871 (49%)

15,431 (52%)

132,828

62,062 (49%)

2,878 (50%)

Lens status

719,173

132,828

Aphakia

1,931 (0.3%)

109 (0.4%)

169 (0.1%)

24 (0.4%)

Phakic

596,616 (87%)

24,235 (81%)

114,674 (90%)

4,795 (84%)

Pseudophakia

90,789 (13%)

5,493 (18%)

12,254 (9.6%)

912 (16%)

LD + hole

719,173

28,504 (4.1%)

1,241 (4.2%)

132,828

20,255 (16%)

476 (8.3%)

Interval from LD dx to prophylaxis

0

NA (NA, NA)

NA (NA, NA)

132,828

28.00 (0.00, 441.00)

17.00 (0.00, 284.00)

Complication post RD

719,173

0 (0%)

4,878 (16%)

132,828

0 (0%)

4,018 (70%)

Follow up (months)

719,173

55.02 (29.10, 86.07)

56.17 (30.47, 85.60)

132,828

58.40 (31.27, 89.40)

68.23 (40.67, 96.70)

1Median (Q1, Q3); n (%)

Table 3: Complication summary of eyes with RD for observation grp

Characteristic

No RD
N = 689,3361

Yes RD
N = 29,8371

p-value2

Sex

<0.001

Female

413,595 (60%)

12,303 (41%)

Male

275,741 (40%)

17,534 (59%)

Race

<0.001

Asian

35,533 (5.2%)

1,017 (3.4%)

Black Or African American

63,366 (9.2%)

1,588 (5.3%)

Other

79,313 (12%)

3,647 (12%)

White

511,124 (74%)

23,585 (79%)

Ethnicity

<0.001

Hispanic Or Latino

45,730 (6.6%)

1,746 (5.9%)

Not Hispanic Or Latino

643,606 (93%)

28,091 (94%)

Region

<0.001

Midwest

128,070 (19%)

6,724 (23%)

Northeast

153,542 (22%)

4,708 (16%)

South

228,802 (33%)

9,114 (31%)

U.S. territories

2,060 (0.3%)

42 (0.1%)

Unknown

96,129 (14%)

5,711 (19%)

West

80,733 (12%)

3,538 (12%)

Age at LD diagnosis

59.00 (46.00, 68.00)

57.00 (49.00, 64.00)

<0.001

LD + hole

28,504 (4.1%)

1,241 (4.2%)

0.837

Right eye

337,871 (49%)

15,431 (52%)

<0.001

Lens status

<0.001

Aphakia

1,931 (0.3%)

109 (0.4%)

Phakic

596,616 (87%)

24,235 (81%)

Pseudophakia

90,789 (13%)

5,493 (18%)

Interval from LD dx to prophylaxis

NA (NA, NA)

NA (NA, NA)

Complication

>0.999

Epiretinal Membrane

0 (NA%)

0 (0%)

Metamorphopsia

0 (NA%)

0 (0%)

Pneumatic Retinopexy

0 (NA%)

195 (4.0%)

Postoperative Vitreous Hemorrhage

0 (NA%)

0 (0%)

PPV +/- SB

0 (NA%)

1,835 (38%)

Repair of complex RD

0 (NA%)

2,737 (56%)

Scleral buckle

0 (NA%)

111 (2.3%)

Follow up (months)

55.02 (29.10, 86.07)

56.17 (30.47, 85.60)

<0.001

1n (%); Median (Q1, Q3)

2Pearson's Chi-squared test; Wilcoxon rank sum test; Fisher's exact test

Table 4: Complication summary of eyes with RD for Prophylaxis grp

Characteristic

No RD
N = 127,0971

Yes RD
N = 5,7311

p-value2

Sex

<0.001

Female

68,451 (54%)

2,012 (35%)

Male

58,646 (46%)

3,719 (65%)

Race

<0.001

Asian

6,251 (4.9%)

164 (2.9%)

Black Or African American

10,608 (8.3%)

256 (4.5%)

Other

16,096 (13%)

659 (11%)

White

94,142 (74%)

4,652 (81%)

Ethnicity

<0.001

Hispanic Or Latino

9,837 (7.7%)

330 (5.8%)

Not Hispanic Or Latino

117,260 (92%)

5,401 (94%)

Region

<0.001

Midwest

24,714 (19%)

1,229 (21%)

Northeast

23,481 (18%)

820 (14%)

South

41,803 (33%)

1,977 (34%)

U.S. territories

842 (0.7%)

10 (0.2%)

Unknown

20,048 (16%)

868 (15%)

West

16,209 (13%)

827 (14%)

LD + hole

20,255 (16%)

476 (8.3%)

<0.001

Age at LD diagnosis

57.00 (46.00, 64.00)

56.00 (49.00, 62.00)

<0.001

Right eye

62,062 (49%)

2,878 (50%)

0.040

Lens status

<0.001

Aphakia

169 (0.1%)

24 (0.4%)

Phakic

114,674 (90%)

4,795 (84%)

Pseudophakia

12,254 (9.6%)

912 (16%)

Interval from LD dx to prophylaxis

28.00 (0.00, 441.00)

17.00 (0.00, 284.00)

<0.001

Complication

>0.999

Epiretinal Membrane

0 (NA%)

2,071 (52%)

Metamorphopsia

0 (NA%)

4 (<0.1%)

Pneumatic Retinopexy

0 (NA%)

26 (0.6%)

Postoperative Vitreous Hemorrhage

0 (NA%)

1,408 (35%)

PPV +/- SB

0 (NA%)

214 (5.3%)

Repair of complex RD

0 (NA%)

287 (7.1%)

Scleral buckle

0 (NA%)

8 (0.2%)

Follow up (months)

58.40 (31.27, 89.40)

68.23 (40.67, 96.70)

<0.001

1n (%); Median (Q1, Q3)

2Pearson's Chi-squared test; Wilcoxon rank sum test; Fisher's exact test

(a) Observation group
(b) Prophylaxis group
Figure 1: Race
(a) Observation group
(b) Prophylaxis group
Figure 2: Sex
(a) Observation group
(b) Prophylaxis group
Figure 3: Ethnicity
(a) Observation group
(b) Prophylaxis group
Figure 4: Region

1. What is the percentage of patients with lattice degeneration (all variations) with and without prophylaxis (defined by CPT 67145) that progress to retinal detachment (RD) needing repair (as defined by CPT: 67110, 67107, 67108, 67113?)

group_type total rd_cases rd_percentage
Observation 719173 29837 4.148793
Prophylaxis 132828 5731 4.314602
group_type hole total rd_cases rd_percentage
Observation No 689428 28596 4.147786
Observation Yes 29745 1241 4.172130
Prophylaxis No 112097 5255 4.687904
Prophylaxis Yes 20731 476 2.296078

For all eyes

LD Vs LD+hole

Percentage of Patients that progress to RD

2. Of those that received prophylactic treatment (for LD and LD + H) what was the rate of retinal detachment requiring repair over time (T1, 3MO PP, 6MO PP, 1 year PP, 2 years PP, etc. up to as many years available in repository. PP = post-prophylaxis)?

Rate of Retinal Detachment Over Time

3. Is there a difference in visual outcomes between the observation and prophylaxis groups?

The plot shows the comparison of visual acuity at different time points across the two group types.

Plot of Visual Acuity by Timepoint

Observation

Prophylaxis

Comparison of VA for both groups

4. Is there a difference in visual outcomes post retinal detachment repair between observation and prophylaxis groups?

Comparison

Observation

Prophylaxis

Comparison of VA post RD

All data

‘Unknown’ shows where missing demographic data

Table 5: Missing data: Demographic characteristics of patients with Lattice Degeneration

Variable

N = 873,8681

Sex

Female

496,203 (57%)

Male

364,395 (42%)

Unknown

13,270 (1.5%)

Race

Asian

34,261 (3.9%)

Black Or African American

58,528 (6.7%)

Other

88,037 (10%)

Unknown

183,145 (21%)

White

509,897 (58%)

Ethnicity

Hispanic Or Latino

51,620 (5.9%)

Not Hispanic Or Latino

543,505 (62%)

Unknown

278,743 (32%)

urban_rural

Rural

70,013 (8.0%)

Unknown

3,095 (0.4%)

Urban

800,760 (92%)

Region

Midwest

152,401 (17%)

Northeast

192,771 (22%)

South

265,517 (30%)

U.S. territories

5,684 (0.7%)

Unknown

123,781 (14%)

West

133,714 (15%)

Follow up (months)

48.67 (53.67)

1n (%); Median (IQR)

The echo: false option disables the printing of code (only output is displayed).